Surgical implant

ABSTRACT

A surgical implant for fixing a soft tissue to a bone comprising a staple and a plate. The staple and the plate are positionable on an instrument in such a way that the plate may be manipulated with the instrument to hold the soft tissue against the bone and in such a way that the staple is fixable to the bone with the plate positioned between a bridge of the staple and the soft tissue when legs of the staple are driven through the plate and into the bone.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application claims benefit of U.S. Provisional ApplicationNo. 61/416,668, filed Nov. 23, 2010, which is hereby incorporated hereinby reference in its entirety.

BACKGROUND OF THE INVENTION

The inventive concepts disclosed herein generally relate to a surgicalimplant. More particularly, the inventive concepts relate to a surgicalimplant for attaching soft tissue, ligaments or tendons to bone.Embodiments of the invention relate to a method for attaching softtissue, ligaments or tendons to bone, to an instrument for implanting asurgical implant according to the invention into a body portion of apatient and to a kit for attaching soft tissue, ligaments or tendons tobone comprising an instrument and one or more surgical implants.

BRIEF SUMMARY OF THE INVENTION

An object of the inventive concepts disclosed herein is to provide asurgical implant allowing soft tissue, such as a ligament or a tendon,to be positioned and held on the surface of a bone before finallyaffixing the soft tissue to the bone.

The inventive concepts disclosed herein relate to a surgical implantcomprising: a staple with two or more legs connected by a bridge, thestaple comprising a material having a tensile strength TS1; and a platewith an upper side and a lower side, and wherein the staple is fixableto a bone with the bridge extending over the plate.

In one embodiment, the legs of the staple can pass through perforationsof the plate. The plate can thus be firmly held in its lateral positionby the legs of the staple.

The surgical implant according to the inventive concepts disclosedherein allows a temporary fixation of the soft tissue by means of theplate and that after a possible correction or adaptation of the positionof the soft tissue the final fixation can be performed by pushing thestaple through or over the temporarily fixed plate.

The surgical implant according to the inventive concepts disclosedherein is a simple and versatile implant for the fixation of soft tissuetears and allows better soft tissue repositioning and better bonyfixation.

In another embodiment, the plate comprises a material having a tensilestrength TS2<TS1 so that the plate may be perforated from its upper sideto its lower side by the legs of the staple. This configuration allowsthe advantage that the plate can be configured without perforations andcan be perforated from its upper side to its lower side by the legs ofthe staple upon impaction of the staple.

In a further embodiment, the plate has a number of blind holes orthrough-going perforations arranged with the same geometry as the legsof the staple. This configuration allows an easier impaction of thestaple through the plate. If the plate comprises through-goingperforations, the plate can consist of the same material as the staple.If the plate comprises blind holes, the plate can be easier perforatedby the legs of the staple so that the insertion of the staple isfacilitated. The through-going perforations or blind holes can have across sectional area which is smaller or equal to the cross sectionalarea of the legs of the staple so that the plate is prevented from alateral movement relative to the staple. Alternatively, thethrough-going perforations or blind holes can have a cross sectionalarea which is larger than the cross sectional area of the legs of thestaple thus allowing a clearance between the legs of the staple and thethrough-going perforations.

In a further embodiment of the surgical implant, the tensile strengthTS1 is comprised in a range of from about 500 MPa to about 3300 MPa.

In another embodiment of the surgical implant, the tensile strength TS2is comprised in a range of from about 60 MPa to about 200 MPa.

In another embodiment of the surgical implant, the material having atensile strength TS1 is a metal or a metal alloy in particular stainlesssteel, titanium alloys, Co Cr alloys and magnesium-based metals.

In a further embodiment of the surgical implant, the material having atensile strength TS2 is a non-resorbable plastic material, preferablychosen from the group of PAEK materials, polyethylene (PE) andpolymethylmethacrylate (PMMA). An exemplary material is PEEK.

In a further embodiment of the surgical implant, the material having atensile strength TS2 is a resorbable plastic material, such as PLLA,PLDLA, PLGA, or PCL.

In again a further embodiment of the surgical implant, the lower side ofthe plate has a roughened or three-dimensionally structure surface, suchas a plurality of pyramid shaped teeth.

In yet a further embodiment of the surgical implant, the plate has acentral hole. This central hole allows attachment of the plate to thefront end of the sleeve of the instrument. The central hole may have aslightly smaller diameter than the front end or alternatively can beshaped conically to be frictionally received over the front end.

In another embodiment of the surgical implant, the legs have taperingends which may be acuminated.

In another embodiment of the surgical implant, the legs have a roughenedor three-dimensional structure, such as a saw-toothing.

In again another embodiment of the surgical implant, the number of thelegs may be three or four.

In yet another embodiment of the surgical implant, the plate has arecess in its upper side for receiving the bridge of the staple. Therecess may be configured and dimensioned to match the bridge of thestaple. This configuration allows the advantage that the plate isretained in its position relative to the staple so that soft tissue,such as a ligament or tendon, can be firmly fixed to a bone.Alternatively, the recess may have a cross sectional area which islarger than the cross sectional area of the bridge of the staple so thatthe bridge is received within the recess with a lateral clearance.

In still another embodiment of the surgical implant, the plate has acentral axis orthogonal to the lower side and further comprises one ormore channels that are open towards the upper side of the plate andextend across the plate orthogonally to the central axis. The channelsfacilitate cutting through the plate and bridge combination and thusfacilitate an explantation of the surgical implant.

In a further embodiment, the plate is configured and dimensioned so thatthe staple engages the plate after fixation of the surgical implant to abone, preferably with the legs laterally contacting the plate. The platecan comprise cutouts arranged, e.g., in the corners so that the legs ofthe staple can be partly received therein. The plate can thus be firmlyheld in its lateral position by the legs of the staple. Alternatively,the legs of the staple can be arranged so that a small spacing remainsbetween the legs and the periphery of the plate.

According to a further aspect of the inventive concepts disclosedherein, there is provided a method for attaching soft tissue, such asligaments or tendons, to bone comprising the following steps:

fixing the soft tissue to the bone surface by pressing a plate with itslower side against the bone;

impacting a staple with its legs through or beside the plate from itsfree upper side so that the legs are anchored in the bone beneath theplate and the soft tissue is clamped between the plate and the bone.

In accordance with another aspect, an instrument for implanting asurgical implant into a body portion of a patient is provided comprisinga longitudinal axis and coaxially arranged thereto: a sleeve having afront end with means for releaseably fixing a plate thereto; an impactrod slideably arranged in the sleeve; an impact block that is affixed tothe impact rod and slideably arranged on the outer peripheral surface ofthe sleeve and that comprises means for releaseably fixing a staplethereto in such a way that the legs of the staple are directed towardsthe front end of the sleeve.

In a further embodiment of the instrument, the staple of the surgicalimplant is attached to the impact block and the plate of the surgicalimplant is attached to the front end of the sleeve and wherein thestaple and the plate are positioned coaxially to each other.

In accordance with again another aspect, a kit is provided for attachingsoft tissue, such as ligaments or tendons, to bone comprising aninstrument according to the inventive concepts disclosed herein and oneor more surgical implants according to the inventive concepts disclosedherein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an embodiment of a surgical implantconstructed in accordance with the inventive concepts disclosed hereinillustrating a staple and a plate separated relationship to one another.

FIG. 2 is a lower perspective view of the surgical implant of FIG. 1showing the staple impacted through the plate.

FIG. 3 is a cross sectional view taken along line 3-3 of FIG. 2.

FIG. 3A is a perspective view of another embodiment of a plate accordingto the inventive concepts disclosed herein.

FIG. 4 is an upper perspective view of another embodiment of a surgicalimplant.

FIG. 5 is a perspective view of an embodiment of an instrument accordingto the inventive concepts disclosed herein.

FIG. 6 is a longitudinal sectional view of the instrument shown in FIG.5.

FIG. 7 is an enlarged sectional view of a portion of the instrumentillustrated in a retracted position with the surgical implant positionedthereon.

FIG. 8 is a sectional view illustrating the instrument in the retractedposition and use of the instrument and the surgical implant to hold softtissue on a bone surface.

FIG. 9 is a sectional view illustrating the instrument in an extendedposition with the staple of the surgical implant having been driventhrough the plate and into the bone to fix the soft tissue to the bone.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

Before explaining at least one embodiment of the inventive concepts indetail, it is to be understood that the inventive concepts disclosedherein are not limited in its application to the details ofconstruction, experiments, exemplary data, and the arrangement of thecomponents set forth in the following description or illustrated in thedrawings. The inventive concepts are capable of other embodiments orbeing practiced or carried out in various ways. Also, it is to beunderstood that the phraseology and terminology employed herein is forpurposes of description and should not be regarded as limiting.

Referring now to the drawings, and more particularly to FIGS. 1-3, oneembodiment of a surgical implant 10 constructed in accordance with theinventive concepts disclosed herein is illustrated. Broadly, thesurgical implant 10 includes a staple 12 and a plate 13.

The staple 12 is illustrated as having four legs 14 connected by abridge 16 that may be formed in the shape of a generally square frame.It should be appreciated, however, that the number of legs 14 may bevaried, as well as the shape of the bridge 16. For example, two or morelegs may be utilized, and the bridge 16 may be formed to have anygeometric, non-geometric, asymmetrical, or fancy design. For example,the bridge 16 may be formed as a rectangle, circle (FIG. 4), triangle,or octagon, or other forms such as stars or hearts. The bridge 16 has acentral opening 17 for receiving a portion of an instrument in a mannerto be described below. Each of the legs 14 is affixed to one corner ofthe bridge 16. The legs 14 are parallel to one another and extendperpendicular from the bottom side of the bridge 16. The free ends ofthe legs 14 are may be acuminated, and the legs 14 may be circularcylindrically configured. Each leg 14 may comprise a three-dimensionalstructure, such as a saw-toothing 18. In one embodiment, thesaw-toothing 18 is located on each leg 14 at a side facing the outerperiphery of the bridge 16. Further, the steep flanks of thesaw-toothing 18 are directed towards the fixed end of each leg 14. Thestaple 12 can be formed of any suitable material such as a 652Lstainless steel with a tensile strength TS1.

In one embodiment, the plate 13 may have a generally square shape withan upper side 22, a lower side 24, four lateral sides 26 a, 26 b, 26 c,and 26 d and a central axis 27 orthogonal to the lower side 24. Like thebridge 16 of the staple 12 discussed above, the plate 13 may be formedto have a variety of shapes. By way of example, FIG. 4 illustratesanother embodiment of a surgical implant 10 a. The surgical implant 10 aincludes a staple 12 a and a plate 13 a. The staple 12 a has a pluralityof legs 14 a and a bridge 16 a. The bridge 16 a and the plate 13 a aresubstantially similar in construction and function to the bridge 16 andthe plate 13 except that the bridge 16 a and the plate 13 a have agenerally circular shape.

Returning now to FIGS. 1-3, the upper side 22 of the plate 13 has arecess 28. The recess 28 of the plate 13 is configured and dimensionedto matingly receive the bridge 16 of the staple 12. The lower side 24 ofthe plate 13 is preferably provided with a three-dimensional structuralsurface, such as a plurality of pyramid shaped teeth 30. The plate 13has a central hole 31 extending through the plate 13 from the upper side22 to the lower side 24 for receiving a portion of an instrument in amanner to be described below.

The plate 13 is further provided with a plurality of perforations 32 forreceiving the legs 14 of the staple 12. Each of the perforations 32 islocated in one corner of the recess 28 that is configured to receive thebridge 16 of the staple 12. When the staple 12 is implanted, the legs 14of the staple 12 are driven through the perforations 32 in the plate 13and into the bone until the bridge 16 abuts the surface of the recess 28so that both the staple 12 and the plate 13 are fixed to the bone. Theplate 13 can consist of the same material as the staple 12, which in oneembodiment is a 652L stainless steel.

Alternatively, the plate 13 may be constructed of a material having atensile strength TS2 which is less that the tensile strength TS1 of thestaple 12. To this end, FIG. 3A illustrates another embodiment of aplate 13 b. The plate 13 b is similar to the plate 13 except that theplate 13 b is formed without the perforations 32. In contrast, the plate13 b is provided with a plurality of blind holes 32 a which can beperforated by the staple 12 upon impaction of the staple 12.

Alternatively, the plate 13 can be configured and dimensioned so thatthe staple 12 embraces the plate 13 after fixation of the surgicalimplant 10 to a bone. The legs 14 of the staple 12 can laterally contactthe plate 13 or can have a small spacing to the periphery of the plate13. In another embodiment, the plate 13 can be provided with fourcutouts or notches for receiving the legs 14 of the staple 12 whereinthe cutouts can be arranged in the corners or sides of the plate 13.

The recess 28 is preferably configured to match the bridge 16 of thestaple 12, allowing mating engagement between the plate 13 and thestaple 12. Alternatively, the perforations 32 can have a diameterallowing the legs 14 of the staple 12 to slideably penetrate through theperforations 32 upon insertion of the staple 12 so that the plate 13 isfixed by the legs 14 of the staple 12 against a lateral movementrelative to the staple 12. As will be understood by those skilled in theart, the plate 13 can be laterally fixed via the staple 12 anchored in abone either by means of a positive locking, if the bridge 16 of thestaple 12 matches the recess 28 in the plate 13, and/or the legs 14match the perforations 32, or by means of a frictional engagement if thebridge 16 of the staple 12 is received in the recess 28 with a clearanceand if the legs 14 have a clearance within the perforations 32, or ifthe legs 14 of the staple 12 are arranged with a small spacing to theperiphery of the plate 13.

The central hole 31 of the plate 13 allows for the attachment of theplate 13 to a front end of an instrument in a manner to be describedbelow in reference to FIGS. 5-7. As such, the central hole 31 can beformed to have a variety of shapes, such as circular cylindrical, solong as the plate 13 can be attached to the front end of the instrument.Alternatively, the central hole 31 in the plate 13 can have a slightlysmaller diameter than the front end of the instrument or the centralhole 31 in the plate 13 can be shaped conically to receive and clamp onan instrument.

Furthermore, the plate 13 may be provided with a first and a secondchannel 33 a and 33 b which penetrate through the plate 13 orthogonallyto a central axis 34. The first and second channels 33 a and 33 b areopen towards the upper side 22 of the plate 13 so as to define cut linesto facilitate explantation of the staple 12 and the plate 13.

FIGS. 5-9 illustrate an embodiment of an instrument 40 for attachingsoft tissue, such as ligaments and tendons, to bone using the surgicalimplant 10. The instrument 40 comprises a longitudinal axis 41 andcoaxially arranged thereto a sleeve 42, an impact rod 44 slideablyarranged in the sleeve 42, and an impact block 46 affixed to the impactrod 44 and slideably arranged on the outer peripheral surface of thesleeve 42. The impact rod 44 can be displaced in the sleeve 42 from aretracted position (FIG. 5-8) where the staple 12 and the plate 13 arein a separated insertion position to an extended position (FIG. 9) wherethe legs 14 of the staple 12 are caused to penetrate through the plate13 and into the bone. The impact rod 44 comprises a central passageway44 a so that the instrument 40 can be pushed over a Kirschner-wire (notshown). The sleeve 42 of the instrument 40 has a front end 54, a rearend 56, and a handle 57. Axially spaced apart from the front end 54, thesleeve 42 comprises two diametrically oppositely arranged slots 58 (onlyone of the slots 58 being visible in FIGS. 6 and 7) extending along thelongitudinal axis 41. The slots 58 are configured and dimensioned toreceive a pair of pins 60 (only one of the pins 60 being visible inFIGS. 7-9) affixed to the impact rod 44 and the impact block 46 so as tointerconnect the impact rod 44 and the impact block 46.

The sleeve 42 can comprise elastic clamping tongs (not shown) at itsfront end 54. The elastic clamping tongs can be configured anddimensioned to be inserted into the central hole 31 of the plate 20 andto resiliently grip the plate 13 so that the plate 13 can be releasablyfixed to the sleeve 42. Alternatively, the front end 54 of the sleeve 42can be configured to be received in the central hole 31, as bestillustrated in FIG. 7, so that the plate 13 can be releaseably attachedto the front end 54 of the sleeve 42 by an interference fit, or thefront end 54 of the sleeve 42 can be conically configured so that aplate 13 having a corresponding conically configured central hole 31 canbe frictionally engaged with the front end 54 of the sleeve 42.

The impact rod 44 of the instrument 40 has a leading end 64, a trailingend 66, and an impact head 68 arranged at the trailing end 66. When theimpact rod 44 is drawn backward in the sleeve 42 into the retractedposition, the trailing end 66 of the impact rod 44 protrudes from therear end 56 of the sleeve 42 and the leading end 64 of the impact rod 44is located within the sleeve 42. The impact head 68 is configured anddimensioned to be impinged on by hammer strokes during insertion of thestaple 12 into the bone.

Near the front end 54 of the sleeve 42, the impact block 46 is coaxiallyslideably arranged about the sleeve 42. As best shown in FIG. 7, thecentral opening 17 of the staple 12 is sized and configured so that thestaple 12 can be positioned on the sleeve 42 a distance from the frontend 54 of the sleeve 42 with the central opening 17 slidingly receivingthe sleeve 42 so that the staple 12 is releasably attached to sleeve 42by an interference fit. Alternatively, the impact block 46 can compriseelastic clamping tongs (not shown) at its forward end. The elasticclamping tongs can be configured and dimensioned to resiliently grip thebridge 16 of the staple 12 so that the staple 12 can be releasably fixedto the impact block 46. Alternatively, a forward end 70 of the impactblock 46 can have a recess which is slightly smaller dimensioned thanthe peripheral surface of the bridge 16 of the staple 12 so that thestaple 12 can be releaseably attached to the forward end 70 of theimpact block 46 by an interference fit.

As mentioned above, the impact block 46 is connected to the impact rod44 by the pins 60. The pins 60 are fixed to the impact rod 44 at theleading end 64 of the impact rod 44 and each extends through one of thetwo slots 58 in the sleeve 42. The staple 12 and the plate 13 arepositioned coaxially to each other. Due to the pins 60 being guided inthe slots 58, the impact block 46 is axially slidable, but non-rotatablydisplaceable relative to the sleeve 42. The non-rotatable positioning ofthe impact block 46 relative to the sleeve 42 causes the legs 14 of thestaple 12 to penetrate through the plate 13 upon impaction of the staple12.

Referring now to FIGS. 8 and 9, in use, a combination of the staple 12and the plate 13 is mounted on the instrument 40. If desired, theinstrument 40 can be aligned with a desired fixation point with aKirschner wire disposed through the passageway 44 a of the instrument40. With the plate 13 attached to the front of the instrument 40, a softtissue 72 (FIG. 8) may be provisionally blocked or held against a bone74 with the plate 13 by pressing the lower side of the plate 12 againstthe soft tissue 72. The staple 12 may then be impacted by hammering onthe impact head 68 so as to move the staple 12 along the sleeve 42 anddrive the legs 14 of the staple 12 through the plate 13 and into thebone 74 so that the legs 14 of the staple 12 are fixed to the bone 74with the soft tissue 72 positioned between the plate 13 and the bone 74and the plate 13 positioned between the bridge 16 of the staple 12 andthe soft tissue 72 (FIG. 9). The instrument 40 may then be retractedthereby releasing the staple 12 and the plate 13 from the instrument.

The following applications of the surgical implants disclosed herein arefeasible: knee region—collateral ligament reconstruction and patellartendon repair; shoulder region—rotator cuff repair, biceps tenodesis,coraco-clavicular ligament repair, AC joint separation reduction, anddeltoid tears repair; foot region—Achilles tendon repair; and generalsurgery—small bone ligamentoplasty, mini-open, open and arthroscopicprocedures are possible.

From the above description, it is clear that the inventive conceptsdisclosed and claimed herein are well adapted to carry out the objectsand to attain the advantages mentioned herein, as well as those inherentin the invention. While several embodiments of the inventive conceptshave been described for purposes of this disclosure, it will beunderstood that numerous changes may be made which will readily suggestthemselves to those skilled in the art and which are accomplished withinthe spirit of the inventive concepts disclosed and/or as defined in theappended claims.

What is claimed is:
 1. A surgical implant, comprising: a staple having abridge and a plurality of legs extending from the bridge, the bridgehaving a central opening extending through the bridge; and a platehaving an upper side and a lower side, the plate having a centralopening and at least one inner protrusion extending from the upper sideadjacent the central opening of the plate, wherein the legs arealignable with the plate and the central opening of the staple isalignable with the central opening of the plate in a way that the stapleis fixable to a bone with the plate positioned between the bridge of thestaple and the bone and the protrusion of the plate is matinglypositioned within the central opening of the staple when the legs of thestaple are driven through the plate and into the bone, wherein the platehas at least one outer protrusion extending from the upper side adjacentan outer peripheral edge of the plate so as to cooperate with the innerprotrusion adjacent the central opening of the plate to define a recessconfigured to matingly receive the bridge of the staple when the legsare driven through the plate and into the bone, the inner protrusionbeing spaced inwardly from the outer peripheral edge of the plate andthe outer protrusion.
 2. The surgical implant of claim 1, wherein theplate has a central axis orthogonal to the lower side and wherein theplate further comprises one or more channels that are open towards theupper side of the plate and extend across the plate orthogonally to thecentral axis intersecting the recess of the plate.
 3. The surgicalimplant of claim 1, wherein the bridge of the staple is substantiallysquare shaped with four corners and wherein one leg extends from each ofthe corners.
 4. The surgical implant of claim 1, wherein the bridge ofthe staple is substantially circularly shaped and wherein the stapleincludes at least four legs extending from the bridge and being equallyspaced about the bridge.
 5. The surgical implant of claim 1 wherein theplate has a plurality of blind holes alignable with the legs of thestaple.
 6. The surgical implant of claim 1 wherein the plate has aplurality of perforations alignable with the legs of the staple.
 7. Thesurgical implant of claim 1, wherein the lower side of the plate has aroughened or three-dimensionally structure surface.
 8. The surgicalimplant of claim 1, wherein the legs have a roughened orthree-dimensionally structure surface.
 9. A surgical implant,comprising: a staple having a bridge and a plurality of legs extendingfrom the bridge, the bridge having a central opening extending throughthe bridge; and a plate having an upper side and a lower side, the platehaving a central opening and at least one inner protrusion extendingfrom the upper side adjacent the central opening of the plate, whereinthe staple comprises a material having a tensile strength and whereinthe plate comprises a material having a tensile strength less than thetensile strength of the staple, wherein the legs are alignable with theplate and the central opening of the staple is alignable with thecentral opening of the plate in a way that the staple is fixable to abone with the plate positioned between the bridge of the staple and thebone and the protrusion of the plate is matingly positioned within thecentral opening of the staple when the legs of the staple are driventhrough the plate and into the bone, wherein the plate has at least oneouter protrusion extending from the upper side adjacent an outerperipheral edge of the plate so as to cooperate with the innerprotrusion adjacent the central opening of the plate to define a recessconfigured to matingly receive the bridge of the staple when the legsare driven through the plate and into the bone, the inner protrusionbeing spaced inwardly from the outer peripheral edge of the plate andthe outer protrusion.
 10. The surgical implant of claim 9, wherein thecentral opening of the staple is non-threaded.
 11. The surgical implantof claim 9, wherein the plate has a central axis orthogonal to the lowerside and wherein the plate further comprises one or more channels thatare open towards the upper side of the plate and extend across the plateorthogonally to the central axis intersecting the recess of the plate.12. The surgical implant of claim 9 wherein the plate has a plurality ofblind holes alignable with the legs of the staple.
 13. The surgicalimplant of claim 9 wherein the plate has a plurality of perforationsalignable with the legs of the staple.